Going private …

The BBC today reported what sounded a little like outrage at the news that University of Central Lancashire is offering a medical degree to overseas students only. The timing plays right into the ‘b****y foreigners coming over here getting our jobs/benefits/houses’ narrative which, unfortunately in my view, seems to have become part of the UK’s political culture. It’s worth looking in detail at what’s going on.

UCLan make the point – fairly – that they don’t have permission to recruit home students – student numbers in Medicine and Dentistry remain capped. See, for instance, this note by HEFCE explaining its role and the caps which apply at England’s medical schools. (nb that there are similar controls in the other UK nations). The devil is in the joint funding by HEFCE and the NHS.

Within the NHS there’s an element of funding – called Service Increment for Teaching (SIFT) – which covers the costs of clinical placements for medical students. These are the costs of having consultants supervise groups of trainee doctors (firms on rotations, if you want the jargon) and are allocated by the relevant medical school to the hospitals and GPs who offer clinical placements.

HEFCE and the NHS see the value in having some overseas students, and so the placement cap includes capped places for overseas students – at about 7.5% of the total cohort. This means that on funded medial programmes, there’s absolutely no crowding out of home students – medical schools simply cannot trade off home for overseas. Look again at the HEFCE note and see the number controls.

UCLan has therefore, in all likelihood, come to a separate deal with the hospitals and GP surgeries where its overseas medical students will undertake their clinical practice. The fee levels quoted suggests that UCLan won’t be making much of a financial surplus on this programme. And for the NHS trusts it gives them a little more income in what will be challenging financial times.

So the anger is misplaced. UCLan aren’t taking away chances from homes students. And if we need more UK doctors, the answer is for the government to fund them.

Carry on doctor!

Medicine – alongside other health professions - is one of the few subjects in UK higher education where workforce planning is a significant part of the equation. Medical Schools are capped on how many students - home and overseas - they can admit. This makes the opening of the UK’s first privately funded medical qualifying degree (since the 1940’s) – at the University of Buckingham – a significant occasion.

The Guardian reports that 500 people applied for its 67 places, and that 60% of its students in this first cohort come from the UK. Fees of £35,000 per year (which is within the range for overseas fees at other UK medical schools) did not deter. (The fee may seem eye-watering, but it doesn’t look to me like profiteering: it does cost a lot to train a doctor, and publicly funded medical education continues, for the time being, to attract a significant subsidy in addition to fee income.)

The critical component of a medical degree is clinical experience, and in this instance the University has agreed with the Milton Keynes NHS Trust that students can undertake clinical placements within the hospital. This benefits the hospital too – there’s prestige and money associated with it.

Finding these clinical placements will have been one of the limiting factors in developing the degree programme. Students spend time with qualified clinicians in every different medical specialty: observing procedures, learning from what they see and practising clinical skills. It’s this that ensures that graduate medics don’t only know about the human body, what ails it and how to cure it; they have some actual experience. But there are only so many clinicians to observe, and only so many patients, so the availability of ‘firms’ (the placement possibility for a group of students) is everything. The negotiations here will have been high stake for the University.

Once students graduate with their degree there’s still a while to go before they are fully licensed: two further years of Foundation Study take place, where they work in clinical settings under the continued supervision of senior doctors. (This is what used to be called the Pre-Registration years.) The University of Buckingham website has a telling phrase:

We expect that our graduates will be eligible to apply for UK Foundation Training posts. (My emphasis.)

Should students worry about being able to continue as doctors? I doubt it: it’s five years until it becomes a live issue, so discussions will still be taking place and contracts not yet signed. My guess is that the NHS Trust will be as keen to have foundation doctors as it was to have undergraduates.

So is this all a good thing? On the positive side, it does get the country more doctors, and that is a good thing. It also shows that alternative models for HE provision can work, and that is arguably a good thing. But in the absence of funding available to all, there’s no doubt that the opportunities available are available, like the Ritz, only for those who can afford it. The Charity Commissioners may be as interested in this degree as they are in the charitable status of public schools...